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Robotic Sacrocolpopexy—Is It the Treatment of Choice for Advanced Apical Pelvic Organ Prolapse?

Abstract

Purpose of Review

Pelvic organ prolapse (POP) is a highly prevalent condition among women that, although non-life threatening, can significantly impact daily activities and quality of life (QOL). Sacrocolpopexy (SC) has been touted by many as the “gold standard,” citing superior anatomic success rates compared to transvaginal approaches for apical prolapse repair. In line with current trends throughout the surgical field, robotic-assisted laparoscopic sacrocolpopexy (RSC) has rapidly gained popularity. This review will present the most contemporary evidence examining RSC and discuss whether it has met criteria to qualify as the “treatment of choice” for advanced apical vaginal prolapse.

Recent Findings

Recent findings support the superior durability of SC for apical prolapse repair compared to native tissue vaginal approaches. Recent evidence demonstrates that anatomic outcomes of minimally invasive sacrocolpopexy, including RSC, are no different than those of traditional ASC. Low quality evidence suggests lower rates of dyspareunia with SC compared to vaginal repairs. RSC may be cost-effective when compared to ASC. When compared to LSC, however, RSC is more expensive and associated with longer operating times.

Summary

RSC is an excellent option for many women who desire the most durable option for definitive repair of advanced apical POP.

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Abbreviations

ASC:

Abdominal sacrocolpopexy

LSC:

Laparoscopic sacrocolpopexy

POP:

Pelvic organ prolapse

POP-Q:

Pelvic organ prolapse quantification

PR:

Posterior repair (posterior colporrhaphy)

QOL:

Quality of life

RCT:

Randomized controlled trial

RSC:

Robotic-assisted laparoscopic sacrocolpopexy

SC:

Sacrocolpopexy

SSLF:

Sacrospinous ligament fixation

USLS:

Uterosacral ligament suspension

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Correspondence to Janine L. Oliver.

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Conflict of Interest

Janine L. Oliver and Ja-Hong Kim have a da Vinci Surgical System® Intuitive Surgical Inc., Sunnyvale, CA, USA at their institution. Currently, the authors perform both open and robotic SC as well as transvaginal approaches for repair of apical prolapse.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

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Oliver, J.L., Kim, JH. Robotic Sacrocolpopexy—Is It the Treatment of Choice for Advanced Apical Pelvic Organ Prolapse?. Curr Urol Rep 18, 66 (2017). https://doi.org/10.1007/s11934-017-0715-6

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Keywords

  • Pelvic organ prolapse
  • Sacrocolpopexy
  • Robotic surgery
  • Sacrocervicopexy
  • Sacral colpopexy
  • Apical prolapse